Introduction
Watch these short clips from the film ‘The time after tsunami’.
Objective
At the end of this part of the case study you will have an overview on how Sphere can be used in planning and implementing a water, sanitation and hygiene promotion response for displaced people.
Question 1
Is the Sphere standard on water quality being met in this displaced camp?
Answer
No.
Water supply standard 2: water quality
‘Water is palatable, and of sufficient quality to be drunk and used for personal and domestic hygiene without causing significant risk to health.’
Relevant indicators
We assess whether the Sphere standard has been met by looking at the indicators. The water quality standard in the Sphere handbook has several indicators, which when used in context will demonstrate whether the standard on water quality is being met:
- A sanitary survey indicates a low risk if faecal contamination
- There are no faecal coliforms per 100ml at the point of delivery
- People drink water form a protected or treated source
How do we find evidence of these indicators?
By observing this film and listening to what people are saying in the film, we can see blocked toilets and poor drainage. It looks as though there is faecal contamination of the drinking water.
Question 2
Is the following statement TRUE or FALSE?
‘Average water use for drinking, cooking and personal hygiene in any household is at least 15 litres per person per day’ is a standard in the Sphere handbook.
Answer
False. It is an indicator, and relates to:
Water supply standard 1: access and water quantity
‘All people have safe and equitable access to a sufficient quantity of water for drinking, cooking and personal and domestic hygiene. Public water points are sufficiently close to households to enable use of the minimum water requirement.’
What is the difference between a standard and an indicator?
The minimum standards are qualitative in nature and specify the minimum levels to be attained; they are universal (everyone around the world needs a sufficient quantity of water), based on the principle that populations affected by disaster have the right to life with dignity.
The key indicators may be qualitative or quantitative. They provide a way of showing whether the standard has been achieved.
Question 3
Which of the choices below are priority actions that could be taken in this situation to improve the supply of quality water? Tick all that apply.
Answer
- A: Send in a tanker of water
Delivering water by tankers may give an immediate water supply, but the source of water needs to be clean and water may need to be chlorinated: this is expensive and is not a long-term solution.
The Sphere handbook guidance notes reminds us to consider sustainability when selecting the water source. Disasters often require a combination of approaches and sources in the initial phase.
Guidance note 2: Water source selection
‘The factors that need to be taken into account are the availability and sustainability of a sufficient quantity of water; whether water treatment is required and, if so, the feasibility of this; the availability of the time, technology or funding required to develop a source; the proximity of the source to the affected population; and the existence of any social, political or legal factors concerning the source. Generally, groundwater sources are preferable as they require less treatment, especially gravity-flow supplies from springs, which require no pumping. Disasters often require a combination of approaches and sources in the initial phase. All sources need to be regularly monitored to avoid over-exploitation.’
The guidance notes give points to consider when applying the standards and indicators. The Sphere handbook says this about guidance notes: they:
include specific points to consider when applying the standards and indicators in different situations, guidance on tackling practical difficulties, and advice on priority issues. They may also include critical issues relating to the standard or indicators, and describe dilemmas, controversies or gaps in current knowledge.
- B: Test the water
Yes. It is a priority to see how contaminated the water is. The Sphere handbook has an indicator linked to the standard on water quality, where there should be no faecal contamination of the water.
Water supply key indicator 2
‘There are no faecal coliforms per 100 ml at the point of delivery.’
- C: Cut off all the water
No. People need water: solutions would be sought immediately to provide water in adequate quantity and of adequate quality.
- D: Do a community mapping
Yes. This is a good idea. It is important to identify the public health risks, involving the community and finding ways to reduce the risks. The Sphere handbook reminds us that the assessment should cover all possible sources of contamination of the water at the source, in transport and in the home, as well as defecation practices, drainage and solid waste management. There is a guidance note on sanitary surveys, which links to this water supply key indicator.
Guidance note 1: Sanitary survey
‘A sanitary survey is an assessment of conditions and practices that may constitute a public health risk. The assessment should cover possible sources of contamination to water at the source, in transport and in the home, as well as defecation practices, drainage and solid waste management. Community mapping is a particularly effective way of identifying where the public health risks are and thereby involving the community in finding ways to reduce these risks. Note that while animal excreta is not as harmful as human excreta, it can contain cryptosporidium, giardia, salmonella, campylobacter, caliciviruses and some other common causes of human diarrhoea and therefore does present a significant health risk.’
Water supply key indicator
‘A sanitary survey indicates a low risk of faecal contamination.’
Further information
It can be seen from these answers that, in situations like this one, there are not always obvious answers. The standards are not always easy to achieve, but, by following the indicators and using them in context, it helps measure and demonstrate whether the standard is being achieved.
Question 4
What are the issues that you noticed in the film on the collection and storage of the water? Tick which you think is correct.
Answer
- A: There were not enough water collecting containers
Yes. It seemed that people didn’t have enough containers. Since a lot of the possessions were lost in the tsunami, it is likely that people needed water containers. It is important that households have enough containers to collect and store water, so that drinking water is safe until consumption.
Water supply standard 3: water facilities and goods
‘People have adequate facilities and supplies to collect, store and use sufficient quantities of water for drinking, cooking and personal hygiene, and to ensure that drinking water remains safe until it is consumed.’
In order to measure whether this standard is met, there are several indicators, one of which is about containers for collecting and storing water
Water key indicator
‘Each household should have at least two clean water collecting containers of 10 – 20 litres, plus enough clean water storage containers to ensure that there is always water in the household.’
- B: Containers were not appropriate
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It is not clear from the film, although some women in the film were complaining that the cooking pots were inappropriate as they do not fit the stoves. There is one view in the film of a woman surrounded by a variety of containers with water.
Water supply standard 3: water facilities and goods
‘People have adequate facilities and supplies to collect, store and use sufficient quantities of water for drinking, cooking and personal hygiene, and to ensure that drinking water remains safe until it is consumed.’
In this standard, the critical point is that water is safe until the point of consumption. Most water contamination occurs at the household level: it can be clean at the source (such as the tap), but then if it is stored in an open container, and hands, animals, chickens are dipping in and out of the water stored, it can quickly become contaminated.
The Sphere guidance notes help us to think about the context. The water pots should be easy to carry and appropriate to the local needs and habits in terms of size, shape and design. In Asia, water is collected in traditional pots with narrow necks. In other area (including Africa) the women may be used to carrying large buckets on their heads.
Guidance note 1: Water collection and storage
‘People need vessels to collect water, to store it and to use it for washing, cooking and bathing. These vessels should be clean, hygienic and easy to carry and be appropriate to local needs and habits, in terms of size, shape and design. Children, disabled people, older people and PLWH/A may need smaller or specially designed water carrying containers. The amount of storage capacity required depends on the size of the household and the consistency of water availability e.g. approximately 4 litres per person would be appropriate for situations where there is a constant daily supply. Promotion and monitoring of safe collection, storage and drawing provide an opportunity to discuss water contamination issues with vulnerable groups, especially women and children.’
Question 5
Watch this section of the film.
There is evidence that the Sphere standards are not being met, because there is not a safe system of disposal of faeces. We hear that the toilets are blocked, the water-flush system is not working, and there is poor drainage.
Write down (using the text box below) at least five important points to consider when planning and implementing an excreta disposal system for displaced people in emergency situations such as this.
Answer
There are many points you may have considered, but using the Sphere handbook you might have come up with the suggestions below.
- Users (especially women) should be consulted about, and approve of, the siting and design of the toilets.
This is an indicator relating to:
Excreta disposal standard 2: design, construction and use of toilets
‘Toilets are sited, designed, constructed and maintained in such a way as to be comfortable, hygienic and safe to use.’
Excreta disposal standard 2: design, construction and use of toilets (p.73)
Often in emergency situations, outsiders come in with the solutions. But it is important to consult the affected community, so that solutions are found in relation to their needs and the context.
The emphasis of the Sphere project is on accountability, which involves listening to people’s needs and responding to their needs, getting feedback and adapting the response.
In the film we hear women complaining, so the response would be more accountable if they were listened to, and of a better quality if the Sphere standard and indicators were followed.
There is also a protection issue in the siting of toilets, as explained in the guidance note, women and girls should feel safe using the toilets throughout the day and the night on safe facilities. The inappropriate siting of toilets may make women vulnerable to attack, especially during the night. Protection is a cross-cutting issue considered throughout the Sphere handbook.
Guidance note 2: Safe facilities
‘Inappropriate siting of toilets may make women and girls more vulnerable to attack, especially during the night, and ways must be found to ensure that women feel, and are, safe using the toilets provided. Where possible, communal toilets should be provided with lighting or families provided with torches. The input of the community should be sought with regard to ways of enhancing the safety of users.’
- Check the number of people per toilet.
The Sphere handbook has indicators on the number of people per toilet. In public places they should be separate for men and women. These indicators link to:
Key indicator 1: Toilet access limit
‘A maximum of 20 people use each toilet’
Excreta disposal standard 1: access to and numbers of toilets
‘People have adequate numbers of toilets, sufficiently close to their dwellings, to allow them rapid, safe and acceptable access at all time of the day and night.’
Excreta disposal standard 1: access to and numbers of toilets (p.71)
It is not always possible in emergency situations to immediately provide enough communal toilets, particularly if there are many displaced people. For this reason, there are guidance notes that help us to consider the context. In some situations space does not allow us to meet the figure of 20 people per toilet. Using the Sphere standards, indicators and guidance notes helps to make decisions, by considering the options and being clear about the aim of achieving the standard. Guidance note 4: Communal toilets, Annex 3.
Guidance note 4: Communal toilets
‘Communal toilets: for a displaced population where there are no existing toilets, it is not always possible to provide one toilet per 20 people immediately. In such cases, a figure of 50 people per toilet can be used, decreasing to 20 as soon as possible, and changing the sharing arrangements accordingly. Any communal toilet must have a system in place, developed with the community, to ensure that it is maintained and kept clean. In some circumstances, space limitations make it impossible to meet this figure. In this case, while advocating strongly for extra space to be made available, it should be remembered that the primary aim is to provide and maintain an environment free from human faeces.’
Appendix 3 offers planning guidelines for minimum numbers of toilets at public places and institutions in disaster situations.
- Toilets all have hand washing facilities.
This is often forgotten; hand washing after defecation and before eating and preparing food is important as a way of preventing the spread of diseases. The is explained in a guidance note linked to the features of toilets, which stresses that users must have the means, after defecation, to wash their hands with soap or an alternative, and they should be encouraged to do so; this links to the importance of hygiene promotion in emergencies.
Guidance note 6: Hand washing
‘The importance of hand washing after defecation and before eating and preparing food, to prevent the spread of disease, cannot be over-estimated. Users should have the means to wash their hands after defecation with soap or an alternative (such as ash), and should be encouraged to do so. There should be a constant source of water near the toilet for this purpose.’
- All toilets that use water for flushing should have a regular supply of water.
In the film the women are complaining that there is not enough water for flushing the toilets. In Asia, the toilets are likely to be pour-flush, so they should have an adequate supply of water.
Key indicator 3: Construction and use of toilets
‘All toilets constructed that use water for flushing and/or a hygienic seal have an adequate and regular supply of water’
In the situation recorded in the film, it would appear that the users were not consulted when the toilets were being designed and built. The type of toilets constructed should depend on the preferences and cultural habits of the intended users, the existing infrastructure and the ready availability of water (for flushing and water seals).
Guidance note 1: Acceptable facilities
‘Successful excreta disposal programmes are based on an understanding of people’s varied needs as well as on the participation of the users. It may not be possible to make all toilets acceptable to all groups and special toilets may need to be constructed for children, older people and disabled people e.g. potties, or toilets with lower seats or hand rails. The type of toilet constructed should depend on the preferences and cultural habits of the intended users, the existing infrastructure, the ready availability of water (for flushing and water seals), ground conditions and the availability of construction materials.’
- Shared or public toilets are cleaned and maintained.
In the film we see that the toilets are dirty, and so are unlikely to be used, and are spreading diseases. An indicator in the Sphere handbook reminds us of the importance of cleaning and maintaining the toilets. It is important in some situations where there are communal toilets that there is a system for regular cleaning and maintenance of the toilets – a dirty toilet will be a health hazard.
Key indicator 4: Access and use of toilets
‘Shared or public toilets are cleaned and maintained in such a way that they are used by all intended users.’
Further information
For more information on safe excreta disposal refer to the Sphere handbook, which has two standards on excreta disposal.
Remember:
‘Safe disposal of human excreta creates the first barrier to excreta-related disease, helping to reduce transmission through direct and indirect routes. Safe disposal is therefore a major priority, and in most disaster situations should be addressed with as much speed and efforts as the provision of safe water supply. The provision of appropriate facilities for defecation is one of a number of emergency responses essential for people’s dignity, safety, health and well-being.’
Question 6
Hygiene promotion is often defined as being the mix between the population’s knowledge, practice and resources and agency knowledge and resources, which together enable risky hygiene behaviours to be avoided. Which of these are important factors?
All three! The Sphere handbook says:
‘Effective hygiene promotion relies on an exchange of information between the agency and the affected community in order to identify key hygiene problems and to design implement and monitor a programme to promote hygiene practices that will ensure the optimal use of facilities and the greatest impact on public health.’
Hygiene promotion is integral to all the standards in this chapter and can impact positively or negatively on health.
Hygiene promotion standard: programme design and implementation
‘All facilities and resources provided reflect the vulnerabilities, needs and preferences of the affected population. Users are involved in the management and maintenance of hygiene facilities where appropriate.’
Hygiene promotion standard 1: programme design and implementation (p.60)
There is mention in the film for the need for more medical care in the camp; it would be useful in this situation to consider having hygiene promoters/community mobilizers, who could help prevent the spread of disease by reaching all sections of the population. As a rough guide, in a camp scenario there should be two hygiene promoters/community mobilizers per 1,000 members of the target population. The handbook has guidance on how to reach all sections of the community, ensuring community facilitators have the skills to work with different groups in the community (considering gender, culture etc.).
Guidance note 3: Reaching all sections of the population
‘Hygiene promotion programmes need to be carried out with all groups of the population by facilitators who can access, and have the skills to work with, different groups (for example, in some cultures it is not acceptable for women to speak to unknown men). Materials should be designed so that messages reach members of the population who are illiterate. Participatory materials and methods that are culturally appropriate offer useful opportunities for groups to plan and monitor their own hygiene improvements. As a rough guide, in a camp scenario there should be two hygiene promoters/community mobilisers per 1,000 members of the target population. For information on hygiene items, see Non-food items standard 2’
Guidance note 3: Reaching all sections of the population (p.61)
Question 7
What is the problem with drainage in this case study? Enter your responses in the text box below.
Answer
The drainage is poor and there is faecal contamination.
Drainage standard 1: drainage works
‘People have an environment in which the health and other risks posed by water erosion and standing water, including stormwater, flood water, domestic wastewater and wastewater from medical facilities, are minimized.’
There are several indicators to show the drainage standard is being achieved: when there is no standing water around dwellings and that the water point drainage is well planned, built and maintained, following guidance for Wastewater, and Drainage and excreta disposal. See Annex 4 (p.95) to understand the impact of poor drainage.
Key indictaor 1: Standing water
‘Areas around dwellings and water points are kept free of standing wastewater, and stormwater drains are kept clear.’
Guidance note 2: Wastewater
‘Sullage or domestic wastewater is classified as sewage when mixed with human excreta. Unless the settlement is sited where there is an existing sewerage system, domestic wastewater should not be allowed to mix with human waste. Sewage is difficult and more expensive to treat than domestic wastewater. At water points and washing and bathing areas, the creation of small gardens to utilise wastewater should be encouraged. Special attention needs to be paid to prevent wastewater from washing and bathing areas contaminating water sources.’
Guidance note 3: Drainage and excreta disposal
‘Special care is needed to protect toilets and sewers from flooding in order to avoid structural damage and leakage.’
Question 8
It is useful to understand how all the elements of the water supply, sanitation and hygiene promotion section of the Sphere handbook fit together.
Without using the Sphere handbook, put these standards and appendices into the boxes below. These boxes mirror the main structure of the water supply, sanitation and hygiene promotion section of the Sphere handbook. Remember that not all of the empty boxes below need filling.
Conclusion
Remember the principle of ‘the right to life with dignity’ in the Humanitarian Charter. Everyone has a right to water; people need water for a dignified life.
The water supply, sanitation and hygiene promotion chapter in the Sphere handbook should be used in conjunction with other chapters, not forgetting the common standards.